Surgical access devices having a variable tissue approach angle

ABSTRACT

Surgical access devices having wound closure features incorporated as part of the device are provided. The devices allow suture to be inserted directly into the device and operated to close an opening through which the device is disposed as or shortly after the device is removed from the surgical site. Further, the wound closure features allow for various orientations of wound closure to be achieved by adjusting an angle at which the suture enters tissue surrounding the opening to be closed. Some of the wound closure features provided for include openings formed in both the housing and cannula of the surgical access device, multiple openings formed in one or both the housing and cannula, locations of the openings being adjustable or otherwise movable, and various flexible seals. Other features, as well as methods of closing an opening through which the surgical access device was disposed, are also provided.

CROSS REFERENCE TO RELATED APPLICATIONS

The present application claims priority to and is a continuation of U.S.patent application Ser. No. 15/088,723 filed on Apr. 1, 2016, issued asU.S. Pat. No. 10,299,785 on May 28, 2019, and entitled “Surgical AccessDevices with Integrated Wound Closure Features,” which is herebyincorporated by reference in its entirety.

FIELD

The present disclosure relates to surgical access devices, and moreparticularly provides for features incorporated into surgical accessdevices that assist in closing an opening in which the surgical accessdevice is disposed while or shortly after the surgical access device isremoved from the surgical site. The disclosure also pertains to methodsrelated to the same.

BACKGROUND

Surgical procedures often require a surgeon to gain access to a cavityin a patient's body. Generally, when such a procedure is required, anincision is made in an exterior wall of the cavity and an instrument isinserted into the working channel created by the incision. One commoninstrument used in such a procedure is a trocar assembly. Trocarassemblies include a variety of components, but generally can include atrocar cannula, a trocar obturator, and a trocar housing. In manydesigns, in order to access the body cavity, the trocar cannula isdirected through the skin and the trocar obturator is inserted throughan interior lumen defined by the cannula. The trocar obturator is thenused to penetrate the skin, which has often already had an incision madein it with a scalpel or similar device, and access the body cavity. Morespecifically, in some designs, applying pressure against a proximal endof the trocar obturator allows a sharp point at a distal end of thetrocar obturator to be forced through the skin until it enters the bodycavity. Then, the trocar cannula is inserted through the perforationmade by the trocar obturator and the trocar obturator is withdrawn,leaving the inner lumen of the trocar cannula as a path to access thebody cavity from outside of the body.

The trocar housing can be joined to a proximal end portion of the trocarcannula, and further, the housing can define a working chamber with anopen distal end portion that is in communication with the interior lumenof the cannula. Just as the interior lumen can receive the obturator, itcan also receive other elongated surgical instruments such that theinstruments can be axially extended into and withdrawn from the cannulathrough the proximal end portion of the working chamber defined by thetrocar housing. For example, in order to allow a surgeon to more easilysee during a procedure, an endoscope can be inserted through the cannulaand proximal or into the body cavity. Further, it is common for one ormore seals to be disposed within the housing and/or the cannula to helpprevent fluid or gas from escaping during surgical procedures. Suchprevention is needed, especially during certain minimally invasivesurgical procedures, in which an insufflations gas is used to expand abody cavity. In many instances, at least two seals are used to helpmaintain a seal while instruments are passed into and out of the workingchannel.

Once a procedure is completed, the trocar is removed and the opening(sometimes referred to herein as a wound) that was formed through whichthe trocar is inserted is typically closed. The size of the opening willdepend on the size of the trocar. Some common trocar sizes includetrocars identified as 5 millimeter trocars, 8 millimeter trocars, 12millimeter trocars, and 15 millimeter trocars, with the size correlatingapproximately to the inner diameter of the cannula. At least foropenings that are 8 millimeters wide or larger, suture is typically usedto close the opening to prevent herinations after surgery. The stitchingof the opening is typically done after the trocar is removed, or atleast a housing portion of the trocar, and thus the ability toinsufflate at that point is lost. The stitching up process typicallyinvolves using additional tools and performing several extra steps afterthe primary surgical method has already been completed. This leads toincreased difficulty in closing the opening, an increased amount of timeto perform the surgery, and a greater likelihood for unnecessary traumato the tissue surrounding the opening. It can be particularly tough tostitch the opening when the cavity wall in which the opening is formedis thick, e.g., approximately equal to or greater than three-quarters ofan inch, as is often the case for abdominal walls.

Accordingly, there is a need to reduce or eliminate the need for extratools to be used to close an opening through which a trocar is passedduring a surgical procedure, and to reduce the amount of steps requiredto close the opening. The solution should provide for a more convenientand easier way for surgeons to close the opening and reduce possibletrauma to the surround tissue and the patient generally.

SUMMARY

Surgical access devices that incorporate wound closure features (oropening closure features) to allow an opening through which the surgicalaccess device is passed to be closed while or shortly after the surgicalaccess device is withdrawn from the opening are provided for in thepresent disclosure. Various configurations provide for sealed openingsassociated with a housing or proximal end of a surgical access device,as well as sealed openings associated with a cannula of the surgicalaccess device. There can be multiple openings associated with each ofthe housing and the cannula, which thus make the wound closure featureadjustable. By passing a suture through different openings, the angle atwhich a suture passes through tissue can be changed. As this angle,referred to herein as a bite angle, is adjusted, in impacts the amountof tissue through which the suture passes and provides for variousconfigurations to close the opening. The adjustability of the bite anglecan be further enhanced by providing for openings that are movable orare otherwise adjustable as provided for in the present disclosure. Forexample, one or more of the openings can be rotated around a centrallongitudinal axis of the surgical access device, and/or the openingitself can provide for some adjustability by being flexible and/or byproviding for an instrument-receiving opening that is smaller than theopening itself. When the instrument-receiving opening is smaller thanthe opening itself, the instrument-receiving opening can be moved withrespect to the opening itself to adjust the angle at which an instrumentdisposed in the instrument-receiving opening passes through the opening.Still further, the present disclosure also provides for seals thatinclude a patterned guide surface conducive to both position and locatea surgical instrument passed therethrough to a desired position. Theseals are also resistant to tearing, thereby preventing undesirableremnants of the seal from entering the body.

In one exemplary embodiment, a surgical access device includes a housingand a cannula extending distally from the housing. The housing has acentral lumen extending through it and a sidewall disposed around thecentral lumen, while the cannula is in fluid communication with thecentral lumen to define a working channel that is sized and configuredto receive a surgical instrument. The sidewall of the housing has atleast one opening extending through it, with that opening having anopening seal associated with it, and the cannula has at least one sealedopening extending through a sidewall of the cannula. A seal is disposedwithin the working channel. The seal is configured to seal the workingchannel when no surgical instrument is disposed through the seal. Theopening(s) extending through the sidewall of the housing and the sealedopening(s) extending through the sidewall of the cannula are configuredto form a suture path(s). A suture path allows a suture to be passedfrom an outside environment, through the at least opening of thehousing, through the at least one sealed opening of the cannula, and toa surgical site.

The at least one opening that extends through the housing sidewall andthe at least one sealed opening that extends through the cannulasidewall can be configured such that an angle formed between a centrallongitudinal axis extending through the cannula and an axis extendingbetween the at least one opening extending through the housing sidewalland the at least one sealed opening extending through the cannulasidewall is adjustable. A variety of different features that permit theadjustability of this angle, sometimes referred to as a bite angle, areprovided for in the present disclosure. For example, the housingsidewall can include a plurality of openings that extend through thehousing sidewall, with each opening having a seal associated with it. Insuch instances, the angle is adjustable at least by virtue of the axisextending between the openings of the housing sidewall and the cannulasidewall passing through different openings of the plurality of openingsthat extend through the housing sidewall. For instance, in a firstposition, the axis extending between the openings of the housingsidewall and the cannula sidewall can extend between a first opening ofthe plurality of openings extending through the housing sidewall and anopening of the at least one sealed opening extending through the cannulasidewall, and in a second position the same axis can extend between asecond opening of the plurality of openings extending through thehousing sidewall and the opening of the at least one sealed openingextending through the cannula sidewall.

By way of further example, adjustability of the bite angle can beprovided for by the cannula sidewall including a plurality of sealedopenings that extend through the cannula sidewall. In such instances,the angle is adjustable at least by virtue of the axis extending betweenthe openings of the housing sidewall and the cannula sidewall passingthrough different sealed openings of the plurality of sealed openingsthat extend through the cannula sidewall. For instance, in a firstposition, the axis extending between the openings of the housingsidewall and the cannula sidewall can extend between an opening of theat least one opening extending through the housing sidewall and a firstsealed opening of the plurality of sealed openings extending through thecannula sidewall, and in a second position the same axis can extendbetween the opening of the at least one opening extending through thehousing sidewall and a second sealed opening of the plurality of sealedopenings extending through the cannula sidewall.

By way of still further example, adjustability of the bite angle can beprovided for by one or more elongate openings. The at least one openingextending through the housing sidewall can include an elongate openinghaving an elongate length that extends substantially parallel to thecentral longitudinal axis. The elongate opening can further include anadjustable entry point that is movable along the elongate length toadjust the angle formed between the central longitudinal axis and theaxis extending between the elongate opening and the at least one sealedopening of the cannula sidewall.

By way of yet another example, adjustability of the bite angle can beprovided by a housing that includes a first rotary disc and a secondrotary disc that are each configured to rotate about the centrallongitudinal axis extending through the cannula. Further, each disc caninclude one or more openings of the opening(s) that extend through thehousing sidewall disposed on the respective discs, with the openingdisposed on the first disc being referred to at least in this instanceas a first opening and the opening disposed on the second disc beingreferred to at least in this instance as a second opening. The first andsecond openings can be movable, e.g., by rotating them about the centrallongitudinal axis, to adjust the angle formed between the centrallongitudinal axis extending through the cannula and the axis extendingbetween the openings of the housing sidewall and the cannula sidewall.

In some embodiments that include the first and second rotary discs, thefirst and second openings can be configured to be moved to an alignmentposition in which the first and second openings are aligned to form anelongate opening having an elongate length that extends substantiallyparallel to the central longitudinal axis. The elongate opening can beconfigured to allow for multiple entry points of a surgical instrumentto provide the adjustable angle formed between the central longitudinalaxis and the axis extending between the openings of the housing sidewalland the cannula sidewall.

By way of another example, adjustability of the bite angle can becontrolled by a rotary dial. The rotary dial can be configured to movethe at least one opening extending through the housing sidewall. Themovement of this opening adjusts the angle formed between the centrallongitudinal axis and the axis extending between the openings extendingthrough the housing sidewall and the cannula sidewall.

The various embodiments described with respect to the adjustability ofthe bite angle can be combined. By way of non-limiting example, both thehousing sidewall and the cannula sidewall can include multiple openings,any of which can be elongate openings that do or do not have adjustableentry points. By way of further non-limiting example, any number ofopenings formed in the sidewall of the housing can be formed on one ormore rotary discs. By way of still a further non-limiting example, arotary dial can be used to control components such as rotary discsand/or adjustable entry points of elongate openings, among otherfeatures. The angle formed by the central longitudinal axis and the axisextending between the openings of the housing sidewall and the cannulasidewall in any of the provided for embodiments can be adjusted betweenvalues approximately in the range of about 15 degrees to about 60degrees. The angle formed allows different wall thicknesses to be passedthrough. Accordingly, in view of the present disclosures, a range ofwall thicknesses through which an instrument and/or a suture can bepassed in view of the provided for surgical access devices isapproximately in the range of about 1 centimeter to about 5 centimeters.

In some embodiments, the at least one sealed opening of the cannulasidewall can include a seal having a patterned guide surface that facestowards the working channel. The patterned guide surface can beconfigured to direct a surgical instrument through one or morepre-defined resealable openings of the seal. The patterned guide surfacecan include a slidable, floating instrument that allows an angle formedbetween a central longitudinal axis extending through the cannula and anaxis extending between the at least one opening of the housing sidewalland the at least one sealed opening of the cannula sidewall to beadjustable.

A proximal portion of the cannula can have a portion of its sidewallthat is thinner than surrounding portions of the cannula sidewall.Further, the thinner portion can have at least one sealed opening thatextends through the cannula sidewall. In such embodiments, a sealingsleeve that is sized to be disposed over the thinner portion can beincluded. The sealing sleeve can be sized such that an outer diameter ofthe combination of the thinner portion of the sidewall and the sealingsleeve is substantially similar to an outer diameter of the surroundingportions of the cannula sidewall. The sealing sleeve can then providethe sealable nature of the at least one sealed opening of the surgicalaccess device.

In another exemplary embodiment, a surgical access device includes ahousing, a cannula extending distally from the housing, a seal, at leastone entry port, and at least one sealed exit port. The housing and thecannula define a working channel that extends through the twocomponents, with the working channel being sized and configured toreceive a surgical instrument. The seal is disposed within the workingchannel, and is configured to seal the working channel when noinstrument is disposed in it. The at least one entry port is disposed inor proximate to the housing, and has a seal associated with the entryport. The at least one sealed exit port extends through a sidewall ofthe cannula. Further, the entry and exit ports are configured such thatan angle formed between a central longitudinal axis that extends throughthe cannula and an axis that extends between the ports, i.e., the biteangle, is adjustable.

The angle formed between the central longitudinal axis and the axis thatextends between the ports can be adjustable approximately between thevalues of about 15 degrees to about 60 degrees. The angle formed allowsdifferent wall thicknesses to be passed through. Accordingly, in view ofthe present disclosures, a range of wall thicknesses through which aninstrument and/or a suture can be passed in view of the provided forsurgical access devices is approximately in the range of about 1centimeter to about 5 centimeters. In some embodiments, the at least oneentry port can include a plurality of entry ports disposed in orproximate to the housing, with each opening having a seal associatedwith it. In such instances, the angle is adjustable at least by virtueof the axis extending between the entry and exit ports passing throughdifferent entry ports of the plurality of entry ports. For instance, ina first position, the axis extending between the entry and exit portscan extend between a first entry port of the plurality of entry portsand an exit port of the at least one sealed exit port, and in a secondposition the same axis can extend between a second entry port of theplurality of entry ports and the exit port of the at least one sealedexit port.

In some embodiments, the at least one sealed exit port can include aplurality of sealed exit ports that extend through the sidewall of thecannula. In such instances, the angle is adjustable at least by virtueof the axis extending between the entry and exit ports passing throughdifferent sealed exit ports of the plurality of sealed exits ports. Forinstance, in a first position, the axis extending between the entry andexit ports can extend between an entry port of the at least one entryport and a first sealed exit port of the plurality of sealed exit ports,and in a second position the same axis can extend between the entry portof the at least one sealed entry port and a second sealed exit port ofthe plurality of sealed exit ports.

The at least one entry port can include an elongate opening having anelongate length that extends substantially parallel to the centrallongitudinal axis. The elongate opening can further include anadjustable entry point that is movable along the elongate length toadjust the angle formed between the central longitudinal axis and theaxis extending between the elongate opening and the at least one sealedexit port.

The housing can sometimes include both a first rotary disc and a secondrotary disc, with each disc being configured to rotate about the centrallongitudinal axis that extends through the cannula. The first rotarydisc can have disposed on it a first entry port of the at least oneentry port that is disposed in or proximate to the housing, and thesecond rotary disc can likewise have disposed on it a second entry portof the at least one entry port that is disposed in or proximate to thehousing. The first and second entry ports can be movable to adjust theangle formed between the central longitudinal axis and the axisextending between the entry and exit ports.

In some embodiments that include the first and second rotary discs, thefirst and second entry ports can be moved to an alignment position inwhich the first and second entry ports are aligned to form an elongateopening having an elongate length that extends substantially parallel tothe central longitudinal axis. The elongate opening can be configured toallow for multiple entry points of a surgical instrument to provide theadjustable angle formed between the central longitudinal axis and theaxis extending between the entry and exit ports.

In some embodiments, a rotary dial can be included to assist inadjusting the bite angle. The rotary dial can be configured to move theat least one entry port. The movement of the entry port adjusts theangle formed between the central longitudinal axis and the axisextending between the entry and exit ports.

Again, the various embodiments described with respect to different waysby which the bite angle can be adjusted can be combined. By way ofnon-limiting example, there can be multiple entry ports and exit ports,any of which can include elongate openings that do or do not haveadjustable entry points. By way of further non-limiting example, anynumber of entry ports can be formed on one or more rotary discs. By wayof still a further non-limiting example, a rotary dial can be used tocontrol components such as rotary discs and/or adjustable entry pointsof elongate openings, among other features.

In some embodiments, the at least one sealed exit port can include aseal having a patterned guide surface that faces towards the workingchannel. The patterned guide surface can be configured to direct asurgical instrument through one or more pre-defined resealable openingsof the seal. The patterned guide surface can include a slidable,floating instrument entrance that allows an angle formed between thecentral longitudinal axis and the axis extending between the entry andexit ports to be adjustable.

A proximal portion of the cannula can have a portion of its sidewallthat is thinner than surrounding portions of the cannula sidewall.Further, the thinner portion can have at least one sealed exit port thatextends through the cannula sidewall. In such embodiments, a sealingsleeve that is sized to be disposed over the thinner portion can beincluded. The sealing sleeve can be sized such that an outer diameter ofthe combination of the thinner portion of the sidewall and the sealingsleeve is substantially similar to the outer diameter of the surroundingportions of the cannula sidewall. The sealing sleeve can then providethe sealable nature of the at least one sealed exit port of the surgicalaccess device.

An exemplary embodiment of a surgical method includes passing a firstfilament tail through a first opening extending through a sidewall of ahousing of a surgical access device, through a first opening extendingthrough a sidewall of a cannula that extends distally from the housing,and through tissue adjacent to an opening in tissue. The method furtherincludes passing a second filament tail through a second openingextending through the sidewall of the housing of the surgical accessdevice, through a second opening extending through the sidewall of thecannula, and through tissue adjacent to the opening in the tissue.Tension is applied to at least one of the first and second filamenttails, which in turn decreases a size of the opening in the tissue.

In some embodiments, the steps of passing the first and second filamenttails through first and second openings extending through the housingsidewall, respectively, can include selecting one opening of a pluralityof openings that extend through the housing sidewall and are proximateto each other to be the respective first or second opening based on thedesired angle at which the respective first or second filament tail isto be passed through the tissue. Likewise, in some embodiments, thesteps of passing the first and second filament tails through first andsecond openings extending through the cannula sidewall, respectively,can include selecting one opening of a plurality of openings that extendthrough the cannula sidewall to be the respective first or secondopening based on the desired angle at which the respective first orsecond filament tail is to be passed through the tissue.

The at least one of the first and second openings that extend throughthe housing sidewall can include an elongate opening having an elongatelength that extends substantially parallel to a central longitudinalaxis that extends through the cannula. The elongate opening can furtherinclude an adjustable entry point that is movable along the elongatelength. In such embodiments, the method can include moving theadjustable entry point longitudinally to adjust an angle at which therespective first or second filament tail is directed to enter thetissue. Further, the surgical method can include moving at least one ofthe first and second openings that extend through the housing sidewallto adjust an angle at which the respective first or second filament tailis directed to enter the tissue.

In one exemplary embodiment, a surgical access device that includes afirst suture path extending across a working channel of the surgicalaccess device such that one entrance of the first suture path isassociated with a housing of the surgical access device and the otherentrance of the first suture path is associated with a cannula thatextends distally from the housing, the other entrance being locatedapproximately on an opposed side of the device in comparison to theentrance associated with the housing. The device further includes asecond suture path extending across the working channel of the surgicalaccess device such that one entrance of the second suture path isassociated with a housing of the surgical access device at a locationthat is approximately opposed to the entrance of the housing associatedwith the first suture path, and the other entrance of the second suturepath being associated with the cannula at a location that isapproximately opposed to the entrance of the cannula associated with thefirst suture path. The first and second suture paths are configured toallow an angle formed by a central axis extending through at least oneof the paths and a central longitudinal axis of the surgical accessdevice is adjustable. As a result, an angle at which a suture insertionor implant instrument that extends through the path, and thus a sutureassociated with such an instrument, can be adjusted to better configurethe instrument and/or suture to pass through a particular thickness oftissue that is disposed adjacent to the surgical device.

The present disclosure provides a wide variety of ways by which theaforementioned angle can be adjusted with respect to one or both paths.Some non-limiting examples of such features include: multiple openingsbeing formed in one or both of the housing and the cannula, one or morerotary discs having one or more openings of the housing formed in thedisc(s); one or more elongate seals; rotary dials to control, by way ofnon-limiting example, an adjustable entry point that moves along anelongate length of the elongate seal(s); a slidable, floating instrumententrance that is included as part of a seal disposed within theopening(s) of the cannula to permit bite angle adjustment; a seal havinga patterned guide surface that faces towards a working channel of thedevice and is configured to direct a surgical instrument through one ormore pre-defined resealable openings of the seal; a sealing sleeve; and,in embodiments that include a sealing sleeve, a portion of the cannulahaving a thinner portion so that a diameter formed by the cannula andsealing sleeve is substantially similar to an outer diameter of theremainder of the cannula. A person skilled in the art, in view of thepresent disclosure, will understand how such features can be selectivelycombined and/or used independent of all other features to adjust a biteangle without departing from the spirit of the present disclosure.Further, in some embodiments, a seal (e.g., a duckbill seal) can bedisposed within the working channel and can be configured to seal theworking channel when no surgical instrument is disposed in the workingchannel. Further, the angle that is being adjusted can be adjustedbetween values of about 15 degrees to about 60 degrees.

In another exemplary embodiment, a surgical access device includes ahousing having a central lumen that extends through it and a cannulathat extends distally from the housing and is in fluid communicationwith the central lumen to define a working channel that is sized andconfigured to receive a surgical instrument. The housing furtherincludes a sidewall disposed around the central lumen. A suture path isformed between a suture insertion entrance associated with the housingand a suture insertion exit associated with the cannula. An angle atwhich the path extends with respect to a central longitudinal axisextending through the cannula is selectably adjustable. Moreparticularly, the device includes a suture path adjusting element thatis configured to control the angle at which the path extends withrespect to the central longitudinal axis. As a result, a user can adjustthe aforementioned angle, which in turn allows a user to change theangle at which a suture disposed through the suture path enter tissuedisposed proximate to the cannula.

The suture path adjusting element can have a variety of configurationsbased on the present disclosures. By way of two non-limiting examples,the suture path adjusting element can be a rotary dial that controls anadjustable entry port that is a suture insertion entrance disposedwithin an elongate opening associated with the housing, and/or one ormore rotary discs of the housing having one or more openings that serveas suture insertion entrances that can be rotated to adjust the angle.In some embodiments, a second suture path can be provided. The secondsuture path can be controlled by the suture path adjusting element suchthat both paths are adjusted at the same time, or it can beindependently adjustable, for instance by a second suture path adjustingelement. In other embodiments the suture path adjusting element can beconfigured to control both suture paths independently of each other. Theangle that is being adjusted can be adjusted between values of about 15degrees to about 60 degrees.

Other features that can be incorporated in the embodiment focused onselectably adjustable suture path(s) include a slidable, floatinginstrument entrance that is included as part of a seal disposed withinthe opening(s) of the cannula to permit bite angle adjustment; a sealhaving a patterned guide surface that faces towards a working channel ofthe device and is configured to direct a surgical instrument through oneor more pre-defined resealable openings of the seal; a sealing sleeve;and, in embodiments that include a sealing sleeve, a portion of thecannula having a thinner portion so that a diameter formed by thecannula and sealing sleeve is substantially similar to an outer diameterof the remainder of the cannula. A person skilled in the art, in view ofthe present disclosure, will understand how such features can beselectively combined and/or used independent of all other featureswithout departing from the spirit of the present disclosure. Further, insome embodiments, a seal (e.g., a duckbill seal) can be disposed withinthe working channel and can be configured to seal the working channelwhen no surgical instrument is disposed in the working channel.

In still another exemplary embodiment, a surgical access device includesa cannula configured to be disposed in an opening in tissue, the cannulahaving an inner lumen extending therethrough to provide for a workingchannel of the surgical access device. The cannula includes a sidewallextending radially around a central longitudinal axis of the device,which can help define the inner lumen. One or more openings are formedin the sidewall such that the opening forms a passageway between theinner lumen and an outside environment. Each such opening can include aseal disposed therein. The seal can include a patterned guide surfacethat faces towards the inner lumen, and can be configured to direct asurgical instrument through one or more pre-defined resealable openingsof the seal. The pre-defined resealable openings can also be referred toas a pre-defined rupture location. Such openings or locations canminimize or eliminate tear remnants that may result from passing aninstrument through the seal, and can reduce an amount of load to beapplied to an instrument being inserted through the seal to pass theinstrument through the seal.

In some embodiments, the surgical access device can include some or allof the other components provided for herein, including but not limitedone or more of the following features: a housing from which the cannulacan extend distally, with the housing having a central lumen thatextends through the housing such that the central lumen is in fluidcommunication with the inner lumen of the cannula to define the workingchannel; a seal disposed within the working channel of the surgicalaccess device that is configured to seal the working channel when nosurgical instrument is disposed through the seal; one or more openingsformed in a sidewall of the housing, which in turn can define a suturepath between opening(s) in the housing and opening(s) in the cannula;and one or more features configured to allow a bite angle to beadjusted. Some non-limiting examples of features configured to allow abite angle to be adjusted are multiple openings being formed in one orboth of the housing and the cannula, one or more rotary discs having oneor more openings of the housing formed in the disc(s); one or moreelongate seals; rotary dials to control, by way of non-limiting example,an adjustable entry point that moves along an elongate length of theelongate seal(s); a slidable, floating instrument entrance that isincluded as part of the patterned guide surface of the seal to permitbite angle adjustment; and a sealing sleeve that includes the patternedguide surface to help form the sealed opening of the cannula, and insome instances, a portion of the cannula has a thinner portion so that adiameter formed by the cannula and sealing sleeve is substantiallysimilar to an outer diameter of the remainder of the cannula. A personskilled in the art, in view of the present disclosure, will understandhow such features can be selectively combined and/or used independent ofall other features to adjust a bite angle without departing from thespirit of the present disclosure.

BRIEF DESCRIPTION OF DRAWINGS

This disclosure will be more fully understood from the followingdetailed description taken in conjunction with the accompanyingdrawings, in which:

FIGS. 1A-1D are schematic illustrations of an opening formed in tissue;

FIG. 2A is a front view of one exemplary embodiment of a surgical accessdevice;

FIG. 2B is a perspective view of the surgical access device of FIG. 2A;

FIG. 2C is a perspective cross-sectional view of the surgical accessdevice of FIG. 2B taken along line C-C;

FIG. 2D is a perspective, partially transparent view of the surgicalaccess device of FIG. 2B, with a portion of the housing removed;

FIG. 3 is a perspective view of one exemplary embodiment of a sutureimplant device having a suture associated therewith;

FIG. 4A is a perspective, partially transparent view of the surgicalaccess device of FIG. 2A having the suture implant device and suture ofFIG. 3 disposed therethrough;

FIG. 4B is a front view of the surgical access device of FIG. 4A withthe suture implant device removed from the surgical access device;

FIG. 4C is a front view of the surgical access device of FIG. 4B with asecond suture disposed therethrough;

FIG. 4D is a front view of the surgical access device of FIG. 4C havingthe first and second sutures coupled together to form a loop;

FIG. 4E is a front view of the surgical access device of FIG. 4Dillustrating the loop being collapsed;

FIG. 5A is a perspective view of another exemplary embodiment of asurgical access device and a portion of another exemplary embodiment ofa suture implant device;

FIG. 5B is a detailed perspective view of the surgical access device anda portion of the suture implant device of FIG. 5A;

FIG. 5C is a perspective of the surgical access device and the entiresuture implant device of FIG. 5A with the suture implant device beingdisposed through the surgical access device;

FIG. 5D is a perspective view of the surgical access device and sutureimplant device of FIG. 5C with the suture implant device being removedfrom the surgical access device and located adjacent to an opposite sideof the surgical access device;

FIG. 5E is a perspective view of the surgical access device and sutureimplant device of FIG. 5D with the suture implant device disposedthrough the surgical access device;

FIG. 6 is a perspective view of yet another exemplary embodiment of asurgical access device, the device having multiple ports associated witheach of a housing and a cannula of the surgical access device;

FIG. 7 is a perspective view of another exemplary embodiment of asurgical access device having multiple ports associated with each of ahousing and a cannula of the device, as well as a portion of a sutureimplant device disposed through the surgical access device;

FIG. 8 is a perspective view of still another exemplary embodiment of asurgical access device, the device including multiple elongate portsassociated with each of a housing and a cannula of the device, and atleast one of the elongate ports of the housing including an adjustableentry point that is controllable with a rotary dial;

FIG. 9 is a perspective view of the rotary dial of FIG. 8, the rotarydial having multiple suture implant devices disposed therethrough;

FIG. 10 is a perspective cross-sectional view of the surgical accessdevice of FIG. 8 taken along line D-D, the surgical access device havingthe suture implant devices of FIG. 9 disposed therethrough;

FIG. 11 is a front view of the surgical access device of FIG. 8illustrating a suture implant device in two different locations;

FIGS. 12A and 12B are schematic illustrations of the suture implantdevice of FIG. 11 disposed at the two different locations, respectively;

FIG. 13 is a perspective view of another exemplary embodiment of asurgical access device having multiple ports associated with each of ahousing and a cannula of the device, as well as a portion of a sutureimplant device disposed therethrough;

FIG. 14 is a front view of the surgical access device of FIG. 13illustrating the suture implant device of FIG. 13 in two differentlocations;

FIGS. 15A and 15B are schematic illustrations of the suture implantdevice of FIG. 14 disposed at the two different locations, respectively;

FIG. 16 is a perspective view of yet another exemplary embodiment of asurgical access device having multiple ports associated with each of ahousing and a cannula of the device, as well as a portion of a sutureimplant device disposed therethrough;

FIG. 17 is a perspective view of another exemplary embodiment of asurgical access device, the device including multiple elongate portsassociated with a cannula of the device;

FIG. 18A is front view of a seal associated with the elongate ports ofFIG. 17;

FIG. 18B is a side view of the seal of FIG. 18A;

FIG. 19A is front view of one exemplary embodiment of a seal that can beused in conjunction with the elongate ports of FIG. 17;

FIG. 19B is a side view of the seal of FIG. 19A;

FIG. 20A is front view of another exemplary embodiment of a seal thatcan be used in conjunction with the elongate ports of FIG. 17;

FIG. 20B is a side view of the seal of FIG. 20A;

FIG. 21 is a front view of still another exemplary embodiment a surgicalaccess device, the device including a slidable, floating seal associatedwith a cannula of the device and having a suture implant device disposedtherein in two different locations;

FIG. 22A is a schematic side view of the slidable, floating seal and thesuture implant device of FIG. 21, the suture implant device beingdisposed in a resting position;

FIG. 22B is a schematic side view of the slidable, floating seal and thesuture implant device of FIG. 22A, the suture implant device beingdisposed in a first position;

FIG. 22C is a schematic side view of the slidable, floating seal and thesuture implant device of FIG. 22A, the suture implant device beingdisposed in a second position;

FIG. 23 is a side view of another exemplary embodiment of a surgicalaccess device, the device including a sleeve that is used to provide aseal associated with a cannula of the device;

FIG. 24 is a perspective view of the surgical access device of FIG. 23,the device having the sleeve removed from the cannula to expose anopening formed in the cannula; and

FIG. 25 is a perspective view of the sleeve of FIG. 23.

DETAILED DESCRIPTION

Certain exemplary embodiments will now be described to provide anoverall understanding of the principles of the structure, function,manufacture, and use of the devices and methods disclosed herein. One ormore examples of these embodiments are illustrated in the accompanyingdrawings. Those skilled in the art will understand that the devices andmethods specifically described herein and illustrated in theaccompanying drawings are non-limiting exemplary embodiments and thatthe scope of the present disclosure is defined solely by the claims. Thefeatures illustrated or described in connection with one exemplaryembodiment may be combined with the features of other embodiments. Suchmodifications and variations are intended to be included within thescope of the present disclosure. Further, in the present disclosure,like-number components of the various embodiments generally have similarfeatures when those components are of a similar nature and/or a similarpurpose. Additionally, to the extent features, sides, directions, steps,etc. are described herein as being a “first feature” or “firstdirection” or a “second feature” or “second direction,” such numericalordering is generally arbitrary, and thus such numbering can beinterchangeable.

The terms “proximal” and “distal” are used herein with reference to alocation of a clinician with respect to a surgical site, with the term“proximal” referring to the portion closest to the clinician and theterm “distal” referring to the portion located away from the clinician.It will be further appreciated that, for convenience and clarity,spatial terms such as “vertical,” “horizontal,” “up,” and “down” may beused herein with respect to the drawings. However, surgical instrumentsare used in many orientations and positions, and these terms are notintended to be limiting and/or absolute. Further, in some instances,components are referred to interchangeably with and without the term“assembly,” e.g., a trocar and a trocar assembly. There is no particularintention for the terms to refer to different components. Likewise,terms such as “instrument” and “device” may be used interchangeably.

The present disclosure generally provides for a surgical access deviceor system that incorporates features to improve wound (or opening)closure capabilities directly into the device or system. Moreparticularly, the surgical access devices and systems provided for aregenerally described as trocars having both a housing and a cannula, withthe cannula extending distally from the housing. One or more openingsare associated with the housing such that an instrument, device, orsuture passed through the opening also passes through the housing andinto a working channel defined by the housing and the cannula. Likewise,one or more openings are associated with a sidewall of the cannula suchthat an instrument, device, or suture that passes through the one ormore openings associated with the housing and into the working channelcan be passed out of the working channel to an environment outside ofthe cannula via the one or more openings of the cannula sidewall. Thepassageway or path (sometimes referred to herein as a suture path)extending between the opening(s) associated with the housing and theopening(s) associated with the cannula can be sealed such that when noinstrument, device, or suture is passed therethrough, fluid is preventedfrom passing between an environment outside of the surgical accessdevice and the working channel. Suture passed through the surgicalaccess device via the openings associated with the housing and thecannula can be passed into tissue that is proximate to the opening intowhich the surgical access device is disposed and subsequently cinched toclose the opening while or after the surgical access device is removedfrom the opening.

The present disclosure also provides for a number of adjustable featuresthat can be incorporated into the surgical access device to allow forsuture that is disposed through the passageway to be passed into tissueat different angles as desired. These features include using multipleopenings associated with either or both of the housing and the cannula,using components that can adjust a position of the openings with respectto a central longitudinal axis of the surgical access device, usingelongate openings, rotary dials, and/or using flexible seals or sealingcomponents, among other features. FIGS. 1A-1D provide some exemplaryillustrations of potential desired stitching paths for a suture whenclosing an opening formed in tissue. Notably, although in each of theillustrated configurations of FIGS. 1A-1D the openings terminate andthus do not extend fully through tissue, such stitching patterns areequally applicable to openings that do extend fully through tissue, suchas openings through which a trocar assembly is typically disposed.

FIG. 1A provides for one example of a potential desired stitching pathfor closing an opening 6 in tissue 8. As shown, there are two potentialsuture paths 1, 2 that extend proximally to distally from a first (asshown left) side E of a surgical access device (not shown) to a second(as shown right) side F of the surgical access device. A suture can bepassed along one or both paths 1, 2. Further, one or both paths 1, 2 canbe used in combination with two other paths 3, 4 also provided for thatextend proximally to distally from the second side F to the first sideE. As shown, the angles α₁, α₂, α₃, α₄ at which the paths are positionedwith respect to a central longitudinal axis A that extends through theopening 6 (and would extend through a surgical access device whendisposed through an opening), referred to herein as a bite angle, isdifferent for different paths. This is why the ability to adjust thebite angle when the surgical access device is still disposed in theopening is desirable. By being able to adjust the bite angle defined bythe locations of the opening(s) associated with the housing and cannulaof the surgical access device, the different paths illustrated can befollowed by sutures while the device remains in the opening. Prior tothe present disclosure, these varied angles would be created by removingthe surgical access device and then passing the suture through tissue atthe desired angles completely independent of the surgical access device.A person skilled in the art will recognize that bite angles can bemeasured between any two sides of the paths and axes, and thus theillustrated configurations of the bite angles are by no means limitingto defining from where a bite angle is measured.

FIGS. 1B, 1C, and 1D likewise illustrated alternative path options foran opening formed in tissue. More particularly, FIG. 1B illustrates twopaths 1′, 2′ that extend proximally to distally from a first (as shownleft) side E′ of a surgical access device (not shown) to a second (asshown right) side F′ of the surgical access device, and two paths 3′, 4′that extend from the second side F′ to the first side E′ to create biteangles α₁′, α₂′, α₃′, α₄′ with respect to a central longitudinal axis A′that extends through an opening 6 ′ in tissue 8′, while FIG. 1Cillustrates two paths 1″, 2″ that extend proximally to distally from afirst (as shown left) side E″ of a surgical access device (not shown) toa second (as shown right) side F″ of the surgical access device, and onepath 3″ that extends from the second side F″ to the first side E″.Further, FIG. 1D illustrates one path 1′″ that extends from a first (asshown left) side E′″ of a surgical access device (not shown) to a second(as shown right) side F′″ of the surgical access device, and a singlepath 2′″ that extends from the second side F′″ to the first side E′″ tocreate bite angles α₁″, α₂″, α₃″, α₄″ with respect to a centrallongitudinal axis A″ that extends through an opening 6″ in tissue 8″. Inthe FIG. 1D embodiment, the two paths 1′″, 2′″ from a perfectperpendicular angle with respect to each other, and an approximately 45degree bite angle α₁′″, α₂′″ with respect to a central longitudinal axisA′″ that extends through an opening 6′″ in tissue 8′″. A person havingskill in the art will recognize a myriad of paths that can be formed toclose openings or wounds in tissue, and such paths are generallyachievable in view of the disclosures provided for herein.

Trocar Assemblies

FIGS. 2A-2D illustrate one exemplary embodiment of a surgical accessdevice, as shown a trocar or trocar assembly 100. The trocar 100 cangenerally include a trocar cannula 102 and a trocar housing (or handle)104. A number of configurations are available for the housing 104. Inthe illustrated embodiment, the housing 104 has a generally cylindricalshape having a proximal removable cap portion 105 and a distal chamberportion 107, with the cap portion 105 being selectively attachable anddetachable from the distal chamber portion 107. FIG. 2D illustrates aninstance in which the proximal cap portion 105 has been detached fromthe distal chamber portion 107. The trocar housing 104 more generally isdefined by a sidewall 108 that extends circumferentially around acentral longitudinal axis L extending through the trocar assembly 100,and thus the trocar cannula 102. The housing 104 includes a centrallumen 110 extending from an open proximal end portion 104 p to a distalend portion 104 d. The housing 104 can have a variety of componentsdisposed therein, as described below. As shown the cap portion 105selectively mates with distal chamber portion 107 by way of male matingmembers, as shown tabs 112 (FIG. 2C), on the cap portion 105 engagingcomplementary female mating members, as shown slots 114 (FIG. 2C),formed in the distal chamber portion 107. Further, the cap portion 105also provides for female mating members, as shown slots 116, at itsproximal end for receiving various components, such as an obturator (notshown).

The trocar cannula 102 extends distally from the housing 104, and isalso generally defined by a sidewall 118 that extends circumferentiallyaround the central longitudinal axis L. A diameter of the cannula 102 isgenerally smaller than a diameter of the housing 104. Further, thetrocar cannula 102 can define an interior lumen 120 with an openproximal end portion 102 p and an open distal end portion 102 d. Asshown by way of FIGS. 2A and 2C, the proximal end portion 102 p canextend into and be mounted in the distal end portion 104 d of the trocarhousing 104, thus defining a working channel 122 of the surgical accessdevice 100 that extends from the proximal end portion 104 p to the opendistal end portion 102 d of the cannula 102. As a result, the housing104 is in fluid communication with the interior lumen 120 of the trocarcannula 102. Further, an insufflation port 124 can be associated withthe housing 104, as shown the distal chamber portion 107, to control theflow of an insufflation fluid or gas, e.g., carbon dioxide, to asurgical site. More particularly, the insufflation port 124 can includea stop cock valve 126 and a cock valve lever 128, which can worktogether to allow and/or prevent passage of an insufflation fluid or gasthrough flexible tubing into a portion of the trocar housing 104 and thetrocar cannula 102.

One or more seal assemblies can be at least partially positioned withinthe working channel. As shown in FIG. 2C, a first, proximal sealassembly 130 and a second, distal seal assembly 132 are both disposed inthe housing and are both positioned within the working channel 122. Thefirst, proximal seal assembly 130, also referred to as an instrumentseal, is provided for in the illustrated embodiment as part of the capportion 105. The instrument seal 130 can be adapted to cooperate with anexterior of any instrument inserted at least partially through thetrocar cannula 102 such that it can sealingly engage the exterior of theinstrument and thus can prevent the passage of fluids through the trocarhousing 104 when the instrument is present within the trocar assembly100. All sorts of instruments, although primarily surgical instruments,can be inserted at least partially through the trocar cannula 102. Oneexample of such an instrument is an endoscope or a similar device thatenables visualization during minimally invasive surgical procedures. Oneskilled in the art will recognize that many other instruments are knownfor insertion into at least a portion of the trocar cannula 102, andaccordingly, that the proximal seal assembly 130 can likewise sealinglyengage the exterior of those instruments as well.

The second, distal seal assembly 132, also referred to as a zero-closureor duckbill seal, is provided for in the illustrated embodiment as partof the chamber portion 107. The duckbill seal 132 can be configured toform a seal in the working channel 122 when no instrument is disposedtherethrough to thus prevent the leakage of insufflation gases deliveredthrough the trocar housing 104 to the body cavity. As a result, theinsufflation port 124 is configured to be in fluid communication with aportion of the working channel 122 that is disposed distal of theduckbill seal 132. As shown, the duckbill seal 132 has a generallycircular flange 134 with a sidewall 136 extending distally therefrom.The shape of the sidewall 136 can vary, but in the illustratedembodiment, the sidewall 136 includes opposed flaps 135 (only one isillustrated) that extend at an angle toward one another in a distaldirection and that come together at a distal end to form a seal face138. The opposed flaps 135 are movable relative to one another to allowthe seal face 138 to move between a closed position, in which noinstrument is disposed therethrough and the seal face 138 seals theworking channel 122 of the trocar assembly 100, and an open position inwhich an instrument is disposed therethrough.

A person skilled in the art will recognize a variety of ways by whichthe seal assemblies 130, 132 can be disposed in the housing 104, as wellas other locations at which one or more of the sealing assemblies can bedisposed, including within the cannula 102. Further, a person skilled inthe art will recognize that while in an exemplary embodiment two sealassemblies are provided in the working channel 122, in other embodimentsone seal assembly, or more than two seal assemblies, can also be used inthe trocar assembly 100. Still further, a person skilled in the art willrecognize other components and features that can be included as part ofa trocar assembly that can be included as part of the present trocarassembly 100, or other trocar assemblies, without negatively impactingthe adjustability features provided for herein.

The illustrated embodiment of the trocar assembly 100, as well as otherembodiments of trocar assemblies provided for herein, are exemplary,non-limiting embodiments of trocar assemblies with which the featuresrelated to wound closure can be used. A wide variety of trocarassemblies can be easily adapted in view of the present disclosureswithout departing from the spirit of the present disclosure. Someexemplary embodiments of trocar assemblies, and components thereof, areprovided for in U.S. Pat. Nos. 7,981,092, 8,579,807, 8,568,362,8,636,686, 8,690,831, U.S. Patent Application Publication No.2015/0038793, issued as U.S. Pat. No. 10,258,324 on Apr. 16, 2019, andU.S. Patent Application Publication No. 2015/0038994, issued as U.S.Pat. No. 9,700,303 on Jul. 11, 2017, the content of each which is herebyincorporated by reference in its entirety. Further, a person havingskill in the art will recognize typical materials used to form thevarious components of a trocar assembly, and the various sizes of trocarassemblies that can be used. By way of non-limiting examples, trocarassembly sizes with which the present disclosures can be used include ⅔millimeter, 5 millimeter, 8 millimeter, 10/12, millimeter, 15millimeter, and 18 millimeter trocar assemblies. A person skilled in theart will recognize that these trocar sizes generally delineate a size ofan inner diameter of the cannula of the trocar, thus informing a user asize of an instrument that can be disposed through the cannula. An outerdiameter of the trocar is thus larger. By way of non-limiting examples,an outer diameter of a 5 millimeter trocar is typically about 8.0millimeters, and an outer diameter of a 10/12 trocar is typically about15.15 millimeters.

Openings or Ports Formed in Housing and Cannula

As shown best in FIGS. 2B-2D, opposed openings or ports 140 are disposedin the housing 104. The openings 140 can be formed in the sidewall 108of the housing 104, and can extend therethrough, creating a channel 142through which fluid can flow through. In the illustrated embodiment, theopening 140 is substantially circular and the channel 142 substantiallycylindrical, although other shapes and configurations are possiblewithout departing from the spirit of the present disclosure. A seal 144is disposed somewhere along a length of the channel 142. In theillustrated embodiment, the seal 144 is disposed at the opening 140,which serves as a proximal entrance to the channel 142. In otherembodiments, the seal 144 can be disposed further distally along a paththrough the channel 142, i.e., closer to the central longitudinal axisL. In the illustrated embodiment, the entrance into the channel 142 isapproximately flush with the outer sidewall 108, and the channel 142that extends into the working channel 122 is disposed at an obliqueangle β with respect to the central longitudinal axis L such that thechannel terminates distal of the distal-most seal, i.e., the duckbillseal 132, thereby forming a suture path between an outside environmentand a surgical site. The present configuration allows insufflation to besubstantially maintained even as an instrument or suture is passedthrough the channel 142. As shown, the proximal end of the channel 142is disposed approximately in the same horizontal plane as a portion ofthe distal-most seal 132, but it does not have to be so disposed. Theopenings 140 promote fluid communication between an outside environmentand the working channel when the seal 144 associated with the channel142 is open.

FIGS. 2A-2D illustrate opposed openings or ports 160 disposed in thecannula 102 as well. The openings 160 can be formed, and extend through,the sidewall 118 of the cannula 102. A seal 164 is associated with theopening 160, for instance by sitting within the opening 160, or asdescribed in later embodiments, by having a sleeve that serves as a sealdisposed around the cannula at the opening. In some instances, theopenings 160 can be referred to as sealed openings or ports because ofthe proximity of the seal 164 with respect to the opening 160. Theopenings 160 formed in the cannula 102 are accessible by an instrument,device, or suture that is passed through the housing opening 140 andthrough the working channel 122. Thus, a plurality of paths can beformed between the opening(s) 140 of the housing 104 and the opening(s)160 of the cannula 102, the paths passing across the working channel 122of the device 100. The sealed openings or ports 160 can have a varietyof shapes and configurations, but in the illustrated embodiment bothopenings 160 are elongate, having a substantially elliptical shape. Theelongate nature of the ports 160 allows for different bite angles to beachieved, and can be used in conjunction with other adjustabilityfeatures and particularly configured seals to achieve desired results asdescribed herein. The inclusion of openings or ports 140, 160 inassociation with both the housing 104 and the cannula 102 is oneparticularly useful and independently novel aspect of the presentdisclosure. Another separate, but also particularly useful andindependently novel aspect of the present disclosure, is the ability forbite angles to be adjusted across one or more suture paths that areformed through a surgical access device like the trocar assembly 100.

The materials used to form the seals 164, as well as the seals 144associated with the housing 104, can be any materials known to thoseskilled in the art, including but not limited to various elastomers andrubbers, such as polyisoprene, Butyl rubber, anionically polymerizedisoprene (e.g., Kraton® as manufactured by Kraton Polymers of Houston,Tex.), polyurethane, silicone, and other similar materials. Some sealscan be manufactured from more than one of these materials. In theillustrated embodiment, the openings 140 formed in the housing 104 andthe openings 160 formed in the cannula 102 are substantially alignedsuch that longitudinally extending planes that pass through anapproximate entirety of the respective openings 160 are substantiallyparallel to longitudinally extending planes that extend through anapproximate entirety of the respective openings 140 in the housing 104.However, the openings 140, 160 can generally be disposed at any locationaround the circumference of the respective housing 104 and cannula 102as desired, and as described below, their locations can be manipulated.

Suture Insertion Devices and Use of the Same with Trocar Assemblies

FIG. 3 provides for one exemplary embodiment of a suture insertiondevice 1000, also referred to as a suture implant device, that can beused in conjunction with the surgical access devices provided forherein. Such devices are known to those skilled in the art, and thus adetailed explanation as to how they work is unnecessary. Generally, thedevice 1000 includes a proximal handle or gripping portion 1002, anelongate shaft 1004 extending from the proximal handle portion 1002, anda distal tip or needle 1006 that is configured to puncture tissue and/orhold a suture at a position relative to the device 1000 to aid inpassing the suture into and through a surgical access device and theninto tissue disposed proximate to that surgical access device. In theillustrated embodiment, a suture 1010 is coupled to a connecting anchoror member 1012, and the connecting anchor 1012 is coupled to the distaltip 1006 of the device 1000 to secure the suture relative to the device.More particularly, the connecting anchor 1012 has a lumen (not shown)extending through a portion thereof, and the distal tip 1006 of thedevice 1000 and inner walls of the anchor 1012 surrounding the lumen ofthe anchor 1012 are configured to be removably coupled together. Othermechanisms and manners for connecting the suture 1010 to the device 1000are possible. By way of non-limiting example, a spring-biased stylethaving a tip needle can be used, such as an Endo Close™ insertiondevice, as manufactured by Medtronic of Dublin, Republic of Ireland.Further, as described below, the connecting anchor 1012 can bedisconnected from the suture insertion device 1000 and subsequentlycoupled with a second connecting anchor to form a single suture.

One exemplary embodiment of using the suture insertion device 1000 withthe surgical access device 100 is illustrated in FIGS. 4A-4E. As shown,the suture insertion device 1000 can be passed through the opening 140(identified for purposes of FIGS. 4A-4E as 140 a to distinguish it fromthe opposed opening 140, which is identified for purposes of FIGS. 4A-4Eas 140 b) in the housing 104, through the working channel 122, andthrough the sealed opening 160 (identified for purposes of FIGS. 4A-4Eas 160 b to distinguish it from the opposed opening 160, which isidentified for purposes of FIGS. 4A-4E as 160 a) in the cannula 102 thatis opposed to the opening 140 a so that the connecting anchor 1012 andat least a portion of the suture insertion device 1000 is disposedoutside of the surgical access device 100, proximate to tissue in whichthe surgical access device 100 is disposed. The suture 1010 can becoupled to the suture insertion device 1000, for instance by way of theconnecting anchor 1012, and upon exiting the opening 160 b, can bepassed through tissue proximate to an opening in which the surgicalaccess device 100 is disposed for future closure of the opening. Theconnecting anchor 1012, and thus the suture 1010, can be disconnectedfrom the suture insertion device, and the suture insertion deviceremoved, thereby leaving the suture 1010 and connecting anchor 1012 inthe configuration illustrated in FIG. 4B.

The suture insertion device 1000, or another suture insertion device,can also be operated to pass a second suture 1010′ into and through thesurgical access device 100. For example, the device 1000 can be passedinto the other housing opening 140 b, through the working channel 122,and through the other sealed opening 160 a so that a connecting anchoror member 1012′ associated with the second suture 1010′ and at least aportion of the suture insertion device 1000 is disposed outside of thesurgical access device 100, proximate to tissue in which the surgicalaccess device 100 is disposed. Subsequent removal of the sutureinsertion device 1000 can result in the configuration illustrated inFIG. 4C.

As shown in FIG. 4D, the two connecting members 1012, 1012′ can becoupled together so that the first and second sutures 1010, 1010′ form asingle suture loop 1014. In the illustrated embodiment, the members1012, 1012′ are passed through sealed openings 180 located at a distalend 102 d of the cannula 102. The sealed openings 180 can have at leastsome of the same characteristics described above with respect to thesealed openings 160 a, 106 b, thus preventing fluid from unnecessarilypassing between the working channel 122 and the outside environment. Inother embodiments, the connecting members 1012, 1012′ can be coupledoutside of the surgical access device 100, or alternatively, the twosutures 1010, 1010′, and/or additional sutures passed through openings140, 160 of the surgical access device 100, can be operatedindependently to close the opening through which the surgical accessdevice 100 is disposed. Turning back to the illustrated embodiment, theformed loop 1014 can then be closed, for instance by applying tension indirection P and Q to proximal ends 1010 p, 1010 p′ of one or bothsutures 1010, 1010′, respectively, as shown in FIG. 4E. The tension canbe applied as the surgical access device 100 is being removed from theopening in tissue, or after it has been removed, to quickly andefficiently close the opening through which the surgical access device100 was disposed.

Alternative Embodiment of Surgical Access Device and Suture InsertionDevice

FIGS. 5A-5E illustrate another exemplary embodiment of a surgical accessdevice, as shown a trocar assembly 200, as well as another exemplaryembodiment of a suture insertion device 2000. The trocar 200 generallyincludes a trocar cannula 202 and a trocar housing (or handle) 204, andhas similar features and components as the trocar assembly 100.Accordingly, it is unnecessary to discuss in any detail components suchas a removable cap portion 205, distal chamber portion 207, centrallumen 210, interior lumen 220, working channel 222 formed by the centraland interior lumens 210, 220, insufflation port 224, and seals (notshown), among other components. The construction and operation of suchcomponents are understood by a person skilled in the art in view of thedisclosures provided for herein related to such components amongst thevarious provided for embodiments.

One illustrated difference between the trocar 100 and the trocar 200 isthe location of the openings or ports 240 that are associated with thehousing 204. While the openings or ports 240 of the trocar 200 includechannels 242 that extend between an outside environment and the workingchannel 222, and seals 244 (FIG. 5C) associated therewith, an entranceof the channel 242 in FIGS. 5A-5E is not flush with respect to asidewall 208 of the housing 204. As shown, the opposed channels 242extend separate from the sidewall 208, and entrances of the channels 242are further away radially from a central longitudinal axis L′ of thedevice 200 than the outer sidewall 208 is located. Further, asillustrated in FIG. 5E, the entrances are angled with respect to thecentral longitudinal axis L′. More particularly, as shown, an angle γformed by a plane J that extends substantially across the entrance ofthe channel 242 and the central longitudinal axis L′ is oblique. Thechannel 242 still communicates with the working channel 222 and anopposed sealed opening 260 formed in a sidewall 218 of the cannula 202as provided for with respect to the sealed opening 160 of the trocar100, as shown in FIGS. 5C and 5E. Further, the path formed by theopposed openings 240 and 260 is sealed at both ends, for example byproviding for a seal 244 proximate to the entrance of the channel 242and a seal 264 associated with the opening 260 extending through thecannula 202. In the illustrated embodiment, the sealed openings 260 ofthe cannula 202 are formed by openings (not shown) formed in thesidewall 218 and a sleeve 270 disposed around the cannula 202, thesleeve 270 having pre-formed seals 264 formed therein that arecomplementary in shape to the openings 260 such that the combination ofthe openings 260 and the seals 264 form sealed openings of the cannula202. As shown, the sleeve 270 increases a diameter of the cannula 202,but in other embodiments, as described below for instance with respectto FIGS. 23-25, the cannula and/or sleeve can be configured such thatthe diameter of the combination of the cannula and the sleeve isapproximately equal to the diameter of the cannula at locations wherethe sleeve is not disposed.

Further, the suture insertion or implant device 2000 provided for inFIGS. 5A-5E is an alternative arrangement of a suture insertion device.The device 2000 generally includes a proximal handle portion 2002, anelongate shaft 2004, and a distal tip or needle 2006, all of which aresimilarly constructed as the suture insertion device 1000. Oneillustrated difference is that the proximal handle portion 2002 includesa spring-loaded actuator 2003, which is spring-biased into a retainingposition to maintain a location of a suture 2010 (FIG. 5B) with respectto the device 2000. Pressing the actuator 2003 can release the suture2010 from the device 2000, thus allowing the device 2000 to be removedand the suture 2010 used to complete the surgical repair. In someembodiments, a connecting anchor or member 2012 can be used to assist inassociating the suture 2010 with the device 2000, as shown in FIG. 5B.

In use, the suture insertion device 2000 having the suture 2010associated therewith is passed from an outside environment, into theopening 240 through the entrance into the channel 242, through theworking channel 222, and out of the sealed opening 260 to the surgicalsite. The suture 2010 is decoupled from the insertion device 2000 andthe insertion device 2000 is removed. The suture insertion device 2000then has a second suture associated therewith (or, alternatively, asecond suture insertion device is used in conjunction with a secondsuture), is passed from an outside environment, into the opposed opening240 through the entrance into the opposed channel 242, through theworking channel 222, and out of the other sealed opening 260 to thesurgical site. The suture is again decoupled from the insertion device2000 (or second suture insertion device) and the insertion device 2000removed. The sutures can then be operated to close the opening throughwhich the trocar 200 is disposed as or after the trocar 200 is removedfrom the opening.

Surgical Access Devices with Multiple Openings Proximate to Each Other

FIGS. 6 and 7 provide two alternative embodiments of surgical accessdevices having multiple openings associated with each of a housing and acannula, with the openings in each of the housing and cannula beingproximate to each other. In other words, while previous embodimentsincluded multiple openings formed in a housing and multiple openingsformed in a cannula, those openings were generally opposed to each otherso that one opening in a housing and one opening on an opposed side ofthe cannula formed a suture path. There were not multiple openingsformed on the same side of a housing or a cannula to provide varioussuture path options having forming different bite angles. Theembodiments of FIGS. 6 and 7, however, provide multiple openings in thesame component that are proximate to each other, which provides theability for different bite angles to be achieved depending on throughwhich openings a suture insertion device and/or a suture are passed.

As shown in FIG. 6, a trocar 300 having both a housing 304 and a cannula302 extending distally therefrom includes a port extension 301 extendingradially from the otherwise cylindrically-shaped housing 304. Theextension 301 includes a plurality of openings or ports 340 formedtherein, each port or opening serving as an entrance to a channel 342that extends through the extension 301, through the housing 304, andinto a working channel 322 extending through the trocar 300. As withother embodiments, the working channel 322 is formed by a central lumen310 extending through the housing 304 and an interior lumen 320extending through the cannula 302. Each opening 340 can have a seal 344associated therewith, either at the entrance or further in the channel342, between the entrance and the working channel 322. The openings 340can be formed in any pattern, but in the illustrated embodiment thereare three openings 340 having a triangular pattern formed between thethree openings. The extension 301 can be any size and shape, depending,at least in part, on the desired bite angle, the number of desiredopenings 340, and the components and methods with which the trocar 300is designed to be used. In the illustrated embodiment, the extension 301has a substantially pyramidal shape with the openings 340 being formedin a substantially flat, proximal-facing surface 301 f, and an angledside 301 s that extends radially from the sidewall 308 to lead to anouter-most wall 301 w of the substantially flat, proximal-facing surface301 f. Although not illustrated, a complimentary extension, along withone or more openings or ports, can be formed on an opposed side of thedevice 300, or at any other location along a circumference of thehousing 304.

Multiple openings or ports 360 can also be formed in a sidewall 318 ofthe cannula 302, with the multiple openings 360 being proximate to eachother. Similar to the openings 340 of the housing 304, the openings 360can be formed in any pattern, but in the illustrated embodiment thereare three openings 360 having a triangular pattern formed between thethree openings 360, with one opening, a central vertex 360 c (i.e., theopening that is approximately equidistantly spaced from the other twoopenings), being more proximal than the other two, which aresubstantially aligned with respect to a longitudinal axis L″ extendingthrough the device 300. Each of the openings 360 can be sealed inmanners similar to those described elsewhere herein as it pertains toopenings or ports associated with the cannula, and thus in someembodiments can include a seal 364 disposed within each opening 360.Additionally, although not illustrated, openings 360 of the natureillustrated with respect to FIG. 6 can also be formed on an opposed sideof the cannula 302, or at any other location along its circumference.Further, any one of the openings 360 formed in the cannula 302 can beused in conjunction with any one of the openings 340 formed in theextension 301. Each different combination of openings 340, 360 in thehousing 304 and cannula 302 can provide for a different bite angle.

FIG. 7 provides for another configuration of a trocar 400 havingmultiple openings 440, 460 proximate to each other in both a housing 404and a cannula 402 extending distally from the housing 404, respectively,to allow for multiple bite angles. In the illustrated embodiment, thetrocar 400 is disposed in an opening 6″″ formed in tissue 8″″. Theopenings or ports 440 associated with the housing 404 of the illustratedembodiment are configured in a manner similar to the openings 240 of thetrocar 200 of FIGS. 5A-5E, and can be used in conjunction with theopenings 460 to pass a suture along a path extending therebetween andinto tissue to close the opening 6″″ as or shortly after the trocar 400is removed from the opening 6″″.

As shown, three openings or ports 440 extend radially from a sidewall408 of the housing 404, with each port 440 being more distal than anadjacent port. In the illustrated embodiment, the three ports 440 aresubstantially aligned along a longitudinal axis M that is substantiallyparallel to a central longitudinal axis L′″ of the device 400. In otherembodiments, one or more of the ports 440 can be located in a positionthat is at a location other than substantially longitudinally alignedwith one or more of the other ports 440. Each port 440 can include achannel 442 that extends from an outside environment, through thehousing 404 and into a working channel 422 extending through the devicethat is defined by a central lumen 410 of the housing and an inner lumen420 of the cannula 402. In the illustrated embodiment, an entrance ofeach channel 442 is disposed radially further away from the centrallongitudinal axis L′″ than the sidewall 408 is located with respect tothe central longitudinal axis L′″. Each channel 442 includes a seal 444associated therewith, either at the entrance or disposed furtherdistally along the channel 442 so that the outside environment is sealedfrom the working channel 422. A plane J′ extending substantially throughthe entrance of the channel 442 can form an oblique angle δ with respectto the central longitudinal axis L′″.

Multiple openings or ports 460 can also be formed in a sidewall 418 ofthe cannula 402, with the multiple openings 460 being proximate to eachother. Similar to the openings 440 of the housing 404, the openings 460can be formed in any pattern, but in the illustrated embodiment thereare three openings 460 having a triangular pattern formed between thethree openings, with one opening, a central vertex 460 c (i.e., theopening that is approximately equidistantly spaced from the other twoopenings), being disposed to the right of the other two co-alignedvertices as shown. One of the two c-aligned vertices, a proximal-mostvertex 460 p, is more proximal than the other two vertices. Each of theopenings 460 can be sealed in manners similar to those describedelsewhere herein as it pertains to openings or ports form in thecannula, and thus in some embodiments can include a seal 464 disposedwithin each opening 460. Additionally, although not illustrated,openings 460 of the nature illustrated with respect to FIG. 7 can alsobe formed on an opposed side of the cannula 402, or at any otherlocation along its circumference. Further, any one of the openings 460formed in the cannula 402 can be used in conjunction with any one of theopenings 440 extending from the housing 404. Each different combinationof openings 440, 460 in the housing 404 and cannula 402 can provide fora different bite angle. Further, in some embodiments, either or both ofthe openings associated with the housing 404 and the openings 460associated with the cannula 402 can be labeled to help users identifythe bite angles that are achieved. The markings can be formed on thesidewalls 408 and 418 at locations visible to a user and/or visibleusing an endoscope or other viewing instrument to view the markings.

In the illustrated embodiment, a suture insertion or implant device 4000is illustrated passing through a proximal-most opening 440 p of thehousing openings 440 and the proximal-most opening 460 p of the cannulaopenings 460. While the location of an opening 440 in the housing 404through which a suture insertion device can be similar to the locationof an opening 460 in cannula through which the same device is inserted,i.e., the device passing through the proximal-most openings of both thehousing and cannula, a suture insertion device and/or suture can bepassed from any of the openings of the housing to any of the openings ofthe cannula. Accordingly, a first position can be in which a deviceand/or suture passes through the proximal-most housing opening and theproximal-most cannula opening, a second position can be in which adevice and/or suture passes through the proximal-most housing openingand one of the distal-most cannula openings, a third position can be inwhich a device and/or suture passes through the proximal-most housingopening and the other of the distal-most cannula openings, a fourthposition can be in which a device and/or suture passes through themiddle housing opening and the proximal-most cannula opening, and soforth. Any number of positions can be achieved depending, at least inpart, on the number of openings provided in the housing and cannula, theadjustability of those openings (as described below), and the size andshape of the openings and instruments used in conjunction therewith. Inuse, a person skilled in the art, in view of the present disclosures,will recognize how to select different openings to pass an insertioninstrument and/or suture through to achieve desired bite angles. Thevarious bite angles can be used to pass suture into the tissue 8″″ invarious configurations to allow the opening 6″″ to be closed while orshortly after the trocar 400 is removed from the opening 6″″. A personskilled in the art will recognize that while some other surgical accessdevice embodiments provided for herein are not illustrated with respectto a tissue or an opening or wound formed in the tissue, the otherembodiments can be used to close openings in which the surgical accessdevice is disposed while or shortly after the device is removed fromsuch an opening or wound in view of the present disclosures.

Surgical Access Device Having Elongate, Adjustable Openings

FIGS. 8-11 illustrate one exemplary embodiment of a surgical accessdevice, e.g., a trocar 500, having an elongate opening or slot 540formed in a housing 504 of the device 500, with the elongate opening 540including an adjustable entry port 541 that is movable along a length ofthe slot 540 to adjust an angle of a suture insertion or implant deviceor suture that passes therethrough with respect to a centrallongitudinal axis L″″ of the device 500. As shown, the housing 504includes an elongate opening or slot 540 formed in an extension 501 thatextends radially away from a sidewall 508 of the housing 504, althoughin other embodiments the slot 540 can be formed in the sidewall 508itself and/or the extension 501 can be considered to be part of thesidewall 508. The opening 540 can have a variety of shapes andconfigurations, but in the illustrated embodiment the opening 540 iselongate, having a substantially elliptical shape. An adjustable entryport 541, alternatively referred to herein as an instrument receivingopening or an adjustable sealable opening, is disposed within theelongate opening 540 and has a seal 544 associated therewith. The seal544 can be disposed at the surface of the extension 501 as shown, or itcan be disposed at a location more proximate to the central longitudinalaxis L″″. The seal 544 provides a seal between the outside environmentand a working channel 522 of the device 500 that is defined by a centrallumen 510 of the housing 504 and an interior lumen 520 of the cannula502. While in earlier embodiments a channel was associated with thevarious openings 140, 240, 340, 440 that extends through the respectivehousings 104, 204, 304, 404, no such channel is provided for the trocar500 so that the rotation of the openings 540 can be more easilyachieved. Instead, the openings 540 extend a distance into the housingbefore opening to openings formed in the rotary disc 590, as describedin greater detail below.

The adjustable entry port 541 is configured to receive a sutureinsertion or implant device and/or suture therethrough, which in turncan be passed through the working channel 522, a sealed opening 560formed in a sidewall 518 of the cannula 502 that extends distally fromthe housing 504, and to a surgical site. The sealed opening 560 can besealed, for example, by having a seal 564 disposed within the opening560. As described below, the adjustable entry port 541 is movable alonga length of the opening 540 to adjust a bite angle at which theinsertion device and/or suture disposed therethrough passes through theworking channel 522 and into tissue. Although not illustrated, acomplimentary extension having an elongate opening or slot and anadjustable entry port, can be formed on an opposed side of the device500, or at any other location along a circumference of the housing 504.

The adjustable entry port 541 can be moved through the opening 540 usinga variety of different techniques, and in the illustrated embodiment arotary dial 590 is provided to move the adjustable entry port 541. Therotary dial 590, which is illustrated in FIGS. 9 and 10, can be disposeddistal of an entrance of the adjustable entry point 541 and distal of adistal-most seal 532 (typically a duckbill or zero-closure seal)disposed in the housing 504, as best seen in FIG. 10. The rotary dial590 can include one or more receiving openings 592 formed therein forreceiving an instrument to pass from the adjustable entry port 541 tothe working channel 522. The receiving openings 592 can have diametersor widths that are approximately greater than half a radius of therotary dial 590 so that a device passing therethrough can be movedthrough a variety of angles. As shown in FIG. 10, an instrument 5000 canextend from the adjustable entry port 541, through the receiving opening592, and into the working channel 522.

Turning back to FIG. 9, the rotary dial 590 can further include opposedcams 594 that are disposed on a surface 596 of the rotary dial 590, thecams 594 being ramped to allow for adjustability. A seal spring (notshown) can further be disposed therein to bias the rotary dial 590. Inone embodiment, the spring can be biased towards a bottom part of thereceiving opening 592 so that rotation of the cam 594 in a direction Rbiases the rotary dial 590 upward in a direction S, as shown in FIG. 9.Accordingly, as the rotary dial 590 is turned, for example,counterclockwise in the direction R, an instrument 5000 disposed in theopening 592 can slide up the cam 594 in the direction S. Notably, theinstrument 5000 is not necessarily disposed in the opening 592 when thedial 590 is rotated, and in such instances, when the device 5000 iseventually passed through the dial 590, then it attains the illustratedconfiguration set by the rotation of the dial 590.

As shown in FIG. 8, the rotary dial can be rotated in either direction,which in turn causes the adjustable entry port 541 to move up and downthrough the elongate opening 540 to establish a bite angle for thesuture insertion device and associated suture. Further, theaggressiveness of the curve of the cam 594 can impact the bite anglethat is created, with the more aggressive curve creating a greatervariation in bite angle. In the illustrated embodiment, the curves ofthe cams 594 yield a change in bite angle approximately in the range ofabout 15 degrees to about 45 degrees, and in one non-limiting exemplaryembodiment the change in bite angle is about 30 degrees. Further, anouter edge of the rotary dial 590 can include one or more grippingfeatures 598, e.g., ridges, grooves, or the like, to assist a user inbeing able to easily rotate the dial. In some embodiments, the dial 590can be configured to have distinct set positions keyed into it such thatas the dial 590 is rotated, it moves between various preset, keyedconfigurations that result in different bite angles.

FIG. 11 depicts the adjustable entry point 541 (not visible) being movedby rotation of the rotary dial 590 in the counterclockwise direction R.As shown, as the dial 590 is rotated in the counterclockwise directionR, the portion of the instrument 5000 located proximate to theadjustable entry port 541 moves in a downward direction T, while theportion of the instrument 5000 located proximate to sealed openings 560of the cannula 502 move in an upward direction U, thereby decreasing thebite angle associated with the instrument 5000. The two different biteangles with respect to tissue 9 are more clearly illustrated in FIGS.12A and 12B, with an angle ε decreasing in FIG. 12B as the rotary dial590 is moved in the counterclockwise direction R and the adjustableentry point 541 moves distally through the opening 540 (not visible). Inparticular, the illustrated embodiment in FIG. 12A is related to theinstrument 5000 being disposed in a first position G, and theillustrated embodiment in FIG. 12B being related to the instrument 5000being disposed in a second position H, with both positions beingidentified in FIG. 11.

A person skilled in the art will recognize that the components of thesurgical access device 500 can be altered to achieve a variety of otherconfigurations, such as rotation in either direction being able toachieve larger and smaller bite angles, having additional openingsformed in any of the housing 504, the rotary dial 590, and/or thecannula 502 to provide further flexibility and adjustability, etc. Inthe illustrated embodiment, an angle of adjustment is approximately inthe range of about 15 degrees to about 60 degrees, although smaller andlarger angles can be achieved without departing from the spirit of thepresent disclosure. The angle formed allows different wall thicknessesto be passed through. Accordingly, in view of the present disclosures, arange of wall thicknesses through which an instrument and/or a suturecan be passed in view of the provided for surgical access devices isapproximately in the range of about 1 centimeter to about 5 centimeters.

Surgical Access Devices with Openings that Rotate with Respect to aCentral Longitudinal Axis

FIGS. 13 and 14 and FIG. 16 provide two additional embodiments ofsurgical access devices that both provide multiple openings to achievedifferent bite angles, and also provide for movement of the openingswith respect to respective central longitudinal axes of the surgicalaccess devices to provide additional adjustability options for achievinga variety of bite angles. More particularly, the openings are configuredto be rotated about a central longitudinal axis of the surgical accessdevice.

FIGS. 13 and 14 illustrate one exemplary embodiment of a surgical accessdevice, as shown a trocar 600, having openings 640 formed in a housing604 of the trocar 600 that are adjustable. As shown, the housing 604includes a plurality of rotatable discs 609 a, 609 b associated with adistal chamber portion 607 of the housing 604, with a cap portion 605being removably and replaceably attachable to the distal chamber portion607. In the illustrated embodiment, an insufflation port 624 isassociated with the cap portion (FIG. 14), and the two rotatable discs609 a, 609 b are associated with the distal chamber portion 607. Eachdisc 609 a, 609 b can include one or more openings 640 formed therein.The openings 640 can extend towards a central longitudinal axis L′″″ ina manner similar to the openings 540 described above with respect to thedevice of FIGS. 8-11. Although not illustrated, a rotary disc can beprovided below the rotary discs 609 a, 609 b and can operate in a mannersimilar to the rotary disc 590 described above, and thus a channel orpath can be formed between the openings 640, through the openings formedin such a rotary disc, and to a working channel 622 of the trocar, theworking channel 622 being defined by a central lumen 610 of the housing604 and an inner lumen 620 of the cannula 602.

In view of the present disclosures, any of the plurality of housingopenings 640 can be rotated and used in conjunction with any of theplurality of cannula openings 660 to achieve various bite angles. FIG.14 provides one illustration of an insertion instrument 6000 having adifferent bite angle by virtue of being disposed in openings 640 ofdifferent rotary discs 609 a, 609 b. However, a person skilled in theart will also recognize that as any of the discs 609 a, 609 b rotates,and the instrument 6000 can be used in conjunction with other openings660 in the cannula 602, the same housing opening 640 can be used tocreate a different bite angle as well just by virtue of the disc 609 a,609 b in which the instrument 6000 is disposed rotating. As shown, theinstrument 6000 has a first bite angle when the instrument 6000 isdisposed in an opening disposed in the top rotary disc 609 a and ispassed through an elongate sealed opening 660 formed in the cannula 602,while the instrument 6000 has a second bite angle when the device 6000is disposed in an opening 640 disposed in the bottom rotary disc 609 band is passed through a different elongate sealed opening 660 formed inthe cannula 602. Notably, the elongate sealed openings 660 provided forin a sidewall 618 of the cannula 602 of FIG. 14 are elongate along awidth rather than a length, although as described above, eitherconfiguration is acceptable. Seals 664 can be associated with theopenings 660 as described in greater detail in other embodiments. Theachieved bite angles θ of both configurations are illustrated withrespect to tissue 9′ in FIGS. 15A and 15B, with the illustratedembodiment in FIG. 15A being related to the instrument 6000 beingdisposed in a first position G′, and the illustrated embodiment in FIG.15B being related to the instrument 6000 being disposed in a secondposition H′, with both positions being identified in FIG. 14.

FIG. 16 depicts an alternative embodiment of a surgical access device,as shown a trocar 700, having rotary discs 709 a, 709 b. Similar to thesurgical access device of FIGS. 13 and 14, a plurality of discs, asshown the two discs 709 a, 709 b, are included as part of a housing 704of the trocar 700, and each disc 709 a, 709 b includes a plurality ofopenings 740 formed therein. In the embodiment illustrated in FIGS. 13and 14, the openings 740 formed in the discs 609 a, 609 b had a portionof an outer wall of the respective discs 609 a, 609 b disposed around anentirety of each opening 640. In contrast, the openings 740 formed inthe discs 709 a, 709 b include at least one opening 740 that isopen-ended such that the open-ended openings 740 can be moved to analignment position in which one opening 740 associated with one disc 709a is aligned with one opening 740 associated with the other disc 709 bto form an elongate opening 740C. A suture insertion or implantinstrument 7000 and/or suture can then be passed through any portion ofthe formed elongate opening 740C, into a working channel 722 of thetrocar 700 that is formed by a central lumen 710 of the housing 704 andan interior lumen 720 of the cannula 702, through openings 760 formed ina sidewall 718 of the cannula 702, and to a surgical site.

In the illustrated embodiment, multiple elongate openings 740C areformed at the same time, although the openings 740 on each disc 709 a,709 b do not need to be spaced in such a manner. In some instances, onlya single elongate opening 740C is formed when two openings 740 aredisposed in an alignment position with respect to each other. Further,when an opening 740 formed in one disc 709 a is not aligned with anopening 740 formed in an adjacent disc 709 b, a surface of the adjacentdisc 709 b closes the opening 740 of the first disc 709 a such that theopening 740 can be used to receive a suture insertion or implantinstrument and/or suture as described herein. Either or both of thediscs 709 a, 709 b can rotate about a central longitudinal axis L″″″ ofthe surgical access device 700 to selectively move one or more openings740 of a disc 709 a, 709 b into and out of an alignment position.

Similar to other embodiments, the one or more sealed openings 760 can beformed in a sidewall 718 of the cannula 702. In the illustratedembodiment, there are three openings 760 illustrated, each beingelongate along a horizontal plane that is substantially perpendicular tothe central longitudinal axis L″″″ (the plane going into and out of thepaper as shown), with a central vertex 760 c being more distal than twoaligned proximal vertices of a sealed opening triangular configuration.Seals 764 can be associated with the openings 760 as described ingreater detail in other embodiments. Further, although the illustratedembodiments provide for two rotary discs having openings associatedtherewith, fewer or more rotary discs can be incorporated into thehousing of any surgical access device without departing from the spiritof the present disclosure.

One useful and independently novel aspect of the present disclosure isthe ability it provides a user to selectably adjust a bite angle formedbetween a suture path extending between one or more openings associatedwith a housing of a surgical access device and one or more openingsassociated with a cannula of the surgical access device. Whether theability to adjust is a result of the inclusion of multiple openings inassociation with the housing or cannula, the ability to move theopenings with respect to a central longitudinal axis of the surgicalaccess device (e.g., rotate about the central longitudinal axis by wayof one or more rotary discs), the ability to move an adjustable entryport within an elongate seal, the ability to operate a rotary dial tomove an adjustable entry port or openings more generally, or any otheradjustable feature afforded by the present disclosures, the selectableadjustment enhances a surgical procedure because it allows a user tomanipulate the angle at which a suture will enter tissue so that theopening in which the surgical device is inserted can be closed in adesirable manner.

Seals and Sealed Openings of the Cannula

FIG. 17 provides for another exemplary embodiment of a surgical accessdevice, as shown a trocar 800. Similar to previous embodiments, thetrocar 800 includes a housing 804 having a cannula 802 extendingdistally therefrom, and one or more openings 840, 860 are associatedwith each of the housing 804 and cannula 802, respectively, to allow fora path to be formed through which a suture insertion or implantinstrument and/or suture can travel from an outside environment, throughthe housing 804, through a working channel 822 of the device 800 definedby a central lumen 810 of the housing 804 and an interior lumen 820 ofthe cannula 802, through the cannula 802, and to a surgical site. Thefocus of this embodiment is on the sealed openings 860 formed in thecannula 802, which are illustrated in greater detail in FIGS. 18A and18B. As shown in FIG. 17, two opposed sealed openings 860 are formed ina sidewall 818 of the cannula 802. Each opening 860 is elongate andgenerally elliptical in shape. A length l of the sealed openings 860 ina direction substantially along an axis Y that is parallel to a centrallongitudinal axis L′″″″ of the device is greater than a width w of thesealed openings 860. Each sealed opening 860 is formed by forming alumen in the sidewall 818 and associating a seal 864 with the lumen. Invarious embodiments the seal 864 can be positioned within the lumen orovertop of the lumen. As shown, the seal 864 is sized to sit snugglywithin the lumen so that fluid does not generally pass between the seal864 and the portion of the sidewall 818 that defines the lumen.

As shown in FIGS. 17, 18A, and 18B, the seal 864 includes a plurality ofridges 863 formed in a surface that faces towards the working channel822 of the trocar 800. The ridges 863 are in a criss cross pattern suchthat openings 865, also referred as pre-defined tear zones, are formedbetween the ridges 863. One or more of the openings 865 can beconfigured to have an instrument, e.g., a suture insertion or implantdevice, and/or suture passed therethrough and seal around the instrumentand/or suture to maintain a seal between the working channel 822 and asurgical site. The ridges 863 provide both a pre-defined path to whichthe instrument and/or suture can be directed, and also providereinforcement for the seal so that remnants of the seal 864 are notseparated from the rest of the seal as an instrument and/or seal arepassed through the seal. Further, as illustrated best by FIG. 18B, theridges 863 form individual pockets 867 along a length of the seal 864with narrowed neck portions 869 between each pocket 867, thus providingindividual, predefined openings 865 through which instruments and/orsutures can be disposed. Additionally, the preformed patterns minimizean amount of load that needs to be applied to an instrument and/orsuture being passed through the seal 864.

FIGS. 19A-20B illustrate two further, non-limiting embodiments of seals864′, 864″ having patterned guide surfaces that can be associated withthe elongate openings 860 of FIG. 17. The seal 864′ of FIGS. 19A and 19Bincludes a patterned guide surface that has a plurality of pre-formedopenings or tear zones 865′ centrally disposed along a longitudinal axisN of the seal 864′. As with the seal 864, the patterned guide surfacesminimize an amount of load that needs to be applied to an instrumentand/or suture being passed through the seal 864′. The longitudinal axisN is substantially parallel to the central longitudinal axis L′″″″ ofthe surgical access device 800 when the seal 864′ is disposed within theopening 860. Each of the four pre-formed openings 865′ is configured tobe closed when no instrument or suture is disposed therethrough, and isconfigured to seal around and instrument and/or suture that is disposedtherethrough. Each pre-formed opening 865′ can independently open andclose apart from the other pre-formed openings 865′. Similar to the seal864 as best shown in FIG. 19B, a narrowed neck portion 869′ can extendbetween each of the openings 865′ to provide individual, predefinedopenings through which instruments and/or sutures can be disposed. Thematerial disposed around each opening can help reinforce the seal sothat portions surrounding each opening 865′ do not break away from theseal 864′ when an instrument is passed therethrough. Further, the seal864′ can be generally flexible in six degrees, thereby allowing aninstrument disposed through one opening 865′ to be moved with some levelof freedom in two directions longitudinally, horizontally, and throughthe seal 864′. Accordingly, while the selection of which opening 865′ aninstrument and/or suture is passed can impact the associated bite angle,the bite angle can also be adjusted when such instrument and/or sutureis disposed in a single opening 865′ due to the flexibility of the seal864′.

FIGS. 20A and 20B illustrate an alternative embodiment of a seal 865″that includes a patterned guide surface with at least one pre-formedopening 865″ formed therein. As shown, a preformed opening or tear zone865″ can be formed centrally in the seal 864″, with a plurality ofradial arcs 861″ disposed above and below the preformed opening 864′.The seal 864″ is generally configured to allow an instrument and/orsuture associated with the instrument to be passed through the centralopening 865″, and the arcs 861″ can provide flexibility to allow theinstrument and/or suture passing therethrough to be manipulated toachieve various bite angles. The arcs 861″ also provide reinforcementfor the seal 864″ so that portions surrounding the opening 865″ do notbreak away from the seal 864″ when an instrument is passed therethrough.A longitudinal slit 871″ can extend along a length of the seal 864″,thereby providing the ability to insert an instrument and/or a suturethrough any of the arcs 861″ as well. Slits 863″ disposed between eachare 861″ can help form individual pockets 867″ through which aninstrument and/or suture can be disposed, as illustrated in FIG. 20B.

FIGS. 21-22C illustrate an exemplary embodiment of a movable sealassociated with a sidewall of a cannula of a surgical access device. Asshown in FIG. 21, a surgical access device, e.g., a trocar assembly 900,includes a housing 904 and a cannula 902 extending distally therefrom.One or more openings 940, 960 are associated with each of the housing904 and the cannula 902. Further, a movable seal 964 is disposed withinone opening 960 formed in a sidewall 918 of the cannula 902. The movableseal 964 includes a slidable, floating instrument entrance 965 thatallows a bite angle to be adjusted when a suture insertion or implantinstrument and/or suture is disposed therethrough. In an unengagedstate, the slidable, floating resealable instrument entrance 965 can besubstantially centered with respect to the seal 964, and thus theopening 960. When no instrument is disposed therethrough, the slidable,floating resealable instrument entrance 965 maintains a seal between aworking channel 922 defined by a central lumen 910 of the housing 904and an inner lumen 920 of the cannula 902, and an outside environment. Aplurality of slits 963 can be formed in a surface of the seal 964 toassist in providing flexibility in the seal 964. An instrument 9000 canbe passed into the instrument entrance 965, as shown in FIG. 22A, suchthat the seal 964 forms a seal around the instrument 9000. Theinstrument can be manipulated between first and second positions V and Was labeled in FIG. 21 and as illustrated in FIGS. 22B and 22C,respectively. During manipulation, a seal is maintained around theinstrument 9000, as shown in FIGS. 22B and 22C, so that fluid does notpass across the seal 964. Similar to the earlier embodiments, thepre-defined, pre-formed nature of the slidable, floating instrumententrance 965 and associated seal 964 minimizes an amount of load thatneeds to be applied to an instrument and/or suture being passed throughthe seal 964, while also minimizing the risk of a remnant of the sealbody becoming dislodged from the seal 964.

While the construction of the seals provided for herein can themselveslead to flexible seals that permit a bite angle to be adjusted whilereducing the risk of remnants becoming separated from the seal, thematerials used to form the seals can also assist in providingflexibility and a decreased risk of remnant dislodging. Thus, materialsthat are stretchable and tear-resistant are well-suited for use informed sealed openings in the cannula and/or the housing. Somenon-limiting examples of materials that can be used to form the sealsinclude various elastomers and rubbers, such as polyisoprene, Butylrubber, anionically polymerized isoprene (e.g., Kraton® as manufacturedby Kraton Polymers of Houston, Tex.), polyurethane, silicone, and othersimilar materials. One or more materials can be used to form any of theseals provided for herein.

The particular seal constructions provided for herein are useful andindependently novel aspects of the present disclosure. The seals providepre-defined rupture locations that minimize tear remnants that are leftbehind, which is particularly useful for seals formed in a sidewall of acannula of a surgical access device. A person skilled in the art willrecognize that the seals provided for herein can also be usedeffectively in other types or portions of medical devices, as well asother fields that use seals in which the present disclosures will proveuseful.

Seal Sleeve

The surgical access device 200 of FIGS. 5A-5E includes a seal sleeve 270disposed around openings 260 formed in the sidewall 218 of the cannula202 to create a sealed opening. In that embodiment, however, thethickness of the sleeve 270 causes a diameter of the cannula 202 as awhole to be greater at the location of the sleeve 270 than elsewherealong a length of the cannula 202. FIGS. 23-25 provide for analternative embodiment in which a cannula 202′ of a surgical accessdevice, e.g., a trocar assembly 200′, is modified to accommodate athickness of a sleeve 270′ so that a diameter of the cannula 202′ is notnecessarily greater at the portion of the cannula 202′ that includes thesealed openings 260′ and sleeve 270′.

As shown in FIGS. 23 and 24, a surgical access device, e.g., a trocarassembly 200′, includes a housing 204′ and a cannula 202′ extendingdistally therefrom. Each of the housing 204′ and cannula 202′ caninclude at least one opening 240′, 260′, respectively, associatedtherewith for passing a suture insertion or implant instrument and/orsuture therethrough as described above. The opening(s) 260′ in thecannula 202′ can be formed in a proximal portion 202p′ of the cannula202′. In the illustrated embodiment, there are two opposed openings 260′formed in the cannula 202′, although only one is visible Like the otherembodiments provided for, however, any number of openings 260′ can beformed in a sidewall 218′ of the cannula 202′, at most any location andin any number of configurations or patterns.

As described at least with respect to FIGS. 5A-5E, a seal sleeve 270′having one or more pre-formed seals 274′ can be used in conjunction withthe openings 260′ to form a sealed opening that is configured to preventfluid from passing through the opening 260′ when no instrument or thelike is disposed in the seal 264′, and which can seal around aninstrument or the like passed through the seal 264′. In otherembodiments of a sleeve, no pre-formed seal is formed and the sleeveitself is configured to generally form a seal around an instrumentand/or suture passing therethrough, but maintain a seal when nothing ispassed therethrough.

One exemplary embodiment of a seal sleeve 270′ is illustrated in FIG.25. The seal sleeve 270′ is generally cylindrical in shape and includesa lumen 270′ extending therethrough. The lumen 273′ is generally sizedto allow the sleeve 273′ to be elastically coupled to the cannula 202′when the sleeve 270′ is disposed around or on the cannula 202′. Inparticular, the seal sleeve 270′ can be configured to stretch and snapalong any portion of the cannula 202′ wherein openings 260′ designed tohave seals associated therewith are disposed on the cannula 202′. Thesleeve 270′ can have any number of configurations associated with it,including the pre-formed openings 264′ and/or patterned surfacesdescribed above, and it can be made from materials known to thoseskilled in the art for providing sealing characteristics, e.g., variouselastomers and rubbers, such as polyisoprene, Butyl rubber, anionicallypolymerized isoprene (e.g., Kraton® as manufactured by Kraton Polymersof Houston, Tex.), polyurethane, silicone, and other similar materials.One or more materials can be used to form any of the seals provided forherein.

As shown in FIG. 24, a portion of the proximal portion 202p′ can have aportion 219′ of the sidewall 218′ removed to accommodate placement ofthe seal sleeve 270′ over the openings 260′ without increasing adiameter of the device 200′ at the portion that includes both thecannula 202′ and the sleeve 270′. As shown in FIG. 25, the sealingsleeve 270′ has a thickness t, and as shown in FIG. 24, the portion 219′of the sidewall 218′ that is removed results in a recess 215′ disposedbetween two ledges 217′, each ledge 217′ being sized to approximatelyhave the same thickness t as the sleeve 270′. The shape of the recess215′ is such that it is complimentary to the shape of the seal sleeve270′, and thus in the illustrated embodiment it is substantiallycylindrical in shape. When the seal sleeve 270′ is placed in the recess215′, the seal sleeve 270′ can sit approximately flush with the rest ofthe cannula 202′ such that an outer wall of the seal sleeve 270′ isapproximately aligned with the outer sidewall 218′ of the cannula 202′.While the thickness t of the seal sleeve 270′, and thus the thickness tof the ledges 217′, can depend on a variety of factors, including thesize of the cannula (e.g., a thickness of the cannula, which in someembodiments is about 0.8 millimeters), the patient, and the preferencesof the surgeon, in some exemplary embodiments the thickness t can beapproximately in the range of about 0.05 millimeters to about 0.5millimeters, more specifically in some embodiments approximately in therange of about 0.1 millimeters to about 0.3 millimeters, and in onenon-limiting embodiment the thickness t is about 0.4 millimeters.

A person skilled in the art will recognize that the various featuresprovided for across the various embodiments can be used interchangeablyacross other embodiments without departing from the spirit of thepresent disclosure. By way of non-limiting example, to the extent oneembodiment includes an elongate opening and another embodiment does not,the elongate opening can be easily incorporated into the otherembodiment. The ability to transpose one or more features from oneembodiment to any other embodiment is readily understandable in view ofthe present disclosures. In no way is the depiction of one feature inone embodiment limiting of that feature only being able to beimplemented in that embodiment.

Further, a person skilled in the art will appreciate that the presentinvention has application in conventional endoscopic and open surgicalinstrumentation as well application in robotic-assisted surgery.

The devices disclosed herein can be designed to be disposed of after asingle use, or they can be designed to be used multiple times. In eithercase, however, the device can be reconditioned for reuse after at leastone use. Reconditioning can include any combination of the steps ofdisassembly of the device, followed by cleaning or replacement ofparticular pieces, and subsequent reassembly. In particular, the devicecan be disassembled, and any number of the particular pieces or parts ofthe device can be selectively replaced or removed in any combination.Upon cleaning and/or replacement of particular parts, the device can bereassembled for subsequent use either at a reconditioning facility, orby a surgical team immediately prior to a surgical procedure. Thoseskilled in the art will appreciate that reconditioning of a device canutilize a variety of techniques for disassembly, cleaning/replacement,and reassembly. Use of such techniques, and the resulting reconditioneddevice, are all within the scope of the present application.

Preferably, the devices described herein will be processed beforesurgery. First, a new or used instrument is obtained and if necessarycleaned. The instrument can then be sterilized. In one sterilizationtechnique, the instrument is placed in a closed and sealed container,such as a plastic or TYVEK® bag. The container and its contents are thenplaced in a field of radiation that can penetrate the container, such asgamma radiation, x-rays, or high-energy electrons. The radiation killsbacteria on the instrument and in the container. The sterilizedinstrument can then be stored in the sterile container. The sealedcontainer keeps the instrument sterile until it is opened in the medicalfacility.

It is preferred that device is sterilized. This can be done by anynumber of ways known to those skilled in the art including beta or gammaradiation, ethylene oxide, steam.

One skilled in the art will appreciate further features and advantagesof the disclosure based on the above-described embodiments. Accordingly,the disclosure is not to be limited by what has been particularly shownand described, except as indicated by the appended claims. Additionally,while the present disclosures generally discuss passing suture insertionor implant devices and sutures through the paths formed between openingsof the housing and openings of the cannula, a person skilled in the art,in view of the present disclosures, would understand that other devices,instruments, and the like can be passed between the openings and otherfeatures of the surgical access device without departing from the spiritof the present disclosure. All publications and references cited hereinare expressly incorporated herein by reference in their entirety.

What is claimed is:
 1. A surgical access device, comprising: (a) a housing having a top surface, a side surface, and a tapered distal end; (b) a cannula extending distally from the tapered distal end of the housing, wherein the cannula includes a cylindrical sidewall and an elongate opening disposed in the cylindrical sidewall, wherein the housing and the cannula define a working channel extending therethrough that is sized and configured to receive a surgical instrument; (c) a cylindrical sleeve that encircles the cylindrical sidewall of the cannula, wherein the cylindrical sleeve overlies the elongate opening; (d) a seal disposed within the working channel and configured to seal the working channel when no instrument is disposed therethrough; and (e) a first suture channel, wherein the first suture channel extends through the side surface of the housing, passes directly from the housing to the cannula, extends across the working channel, and extends through the elongate opening and the cylindrical sleeve, wherein the first suture channel extends at an oblique angle with respect to a central longitudinal axis extending through the cannula, wherein the oblique angle is selectively adjustable.
 2. The surgical access device of claim 1, further comprising a user control configured to change a size of the oblique angle.
 3. The surgical access device of claim 2, further comprising: a second suture channel extending across the working channel and through the side surface of the housing at a second oblique angle with respect to the central longitudinal axis extending through the cannula; and a second user control configured to change a size of the second oblique angle.
 4. The surgical device of claim 3, wherein the user control and the second user control form a singular user control.
 5. The surgical device of claim 3, wherein the first suture channel has a first entrance disposed proximal of the seal and a second entrance disposed distal of the seal, the second entrance being located approximately on an opposed side of the device in comparison to a location of the first entrance, and wherein the second suture channel has a first entrance disposed proximal of the seal and a second entrance disposed distal of the seal, the first entrance being at a location that is approximately opposed to the first entrance of the first suture channel and the second entrance being at a location that is approximately opposed to the second entrance of the second suture channel.
 6. The surgical access device of claim 5, wherein the first entrances of the first and second suture channels are disposed in or proximate to the housing, and the second entrances of the first and second suture channels extend through a sidewall of the cannula.
 7. The surgical access device of claim 2, wherein the user control comprises a plurality of entry points of the first suture channel disposed proximal of the seal, the entry points being disposed at different locations with respect to the housing such that the oblique angle is different for at least two entry points of the plurality of entry points when an exit point for the first suture channel is the same for the at least two entry points.
 8. The surgical access device of claim 7, wherein the user control further comprises: a first rotary disc having a first entry point of the plurality of entry points disposed proximal of the seal, the first rotary disc being configured to rotate about the central longitudinal axis extending through the cannula; and a second rotary disc disposed distal of the first rotary disc and having a second entry point of the plurality of entry points disposed proximal of the seal, the second rotary disc being configured to rotate about the central longitudinal axis extending through the cannula, and wherein the first and second rotary discs are movable to adjust a location of the first and second entry points, respectively, and in turn the oblique angle.
 9. The surgical access device of claim 8, wherein the first and second rotary discs are configured to be moved to an alignment position in which the first and second entry points are aligned to form an elongate opening having an elongate length that extends substantially parallel to the central longitudinal axis extending through the cannula, the elongate opening being configured to allow for multiple entry points of a suture, with the multiple entry points allowing for a size of the oblique angle to change.
 10. The surgical access device of claim 2, wherein the user control comprises an elongate opening having an elongate length that extends substantially parallel to the central longitudinal axis extending through the cannula, the elongate opening comprising an adjustable entry point movable along the elongate length to adjust the oblique angle.
 11. The surgical access device of claim 2, wherein the user control comprises a rotary dial configured to move an entry point of the first suture channel to adjust the oblique angle.
 12. The surgical access device of claim 1, wherein the first suture channel has a first entrance disposed proximal of the seal and a second entrance disposed distal of the seal, the second entrance being located approximately on an opposed side of the device in comparison to a location of the first entrance.
 13. The surgical access device of claim 12, wherein the first entrance of the first suture channel is disposed in or proximate to the housing, and the second entrance of the first suture channel extends through a sidewall of the cannula.
 14. The surgical access device of claim 1, wherein the cylindrical sleeve is flush with an outermost surface of the cylindrical sidewall of the cannula.
 15. The surgical access device of claim 1, wherein the housing further comprises a removable upper portion, wherein the removeable upper portion defines the top surface and includes an opening configured to provide access to the working channel.
 16. The surgical access device of claim 1, wherein the cannula includes a plurality of ridges spaced axially along a portion of the cannula disposed distally of the cylindrical sleeve.
 17. A surgical access device, comprising: (a) a housing having a top surface, a side surface, and a tapered distal end; (b) a cannula extending distally from the tapered distal end of the housing along a longitudinal axis, wherein the cannula includes a cylindrical sidewall and an elongate opening disposed in the cylindrical sidewall, wherein the housing and the cannula define a working channel configured to receive a surgical instrument therethrough; (c) a cylindrical sleeve that encircles the cylindrical sidewall of the cannula, wherein the cylindrical sleeve overlies the elongate opening; and (d) a suture path, wherein the suture path extends through the side surface of the housing, passes directly from the housing to the cannula, extends across the working channel, and extends through the elongate opening and the cylindrical sleeve, wherein the suture path defines an oblique angle relative to the longitudinal axis, wherein the oblique angle is selectively adjustable.
 18. The surgical access device of claim 17, wherein the suture path comprises a first suture path, wherein the surgical access device further comprises a second suture path extending through the side surface of the housing, across the working channel, and through the sidewall of the cannula.
 19. The surgical access device of claim 18, wherein the oblique angle comprises a first oblique angle, wherein the second suture path defines a second oblique angle relative to the longitudinal axis, wherein the second oblique angle is selectively adjustable.
 20. The surgical access device of claim 19, wherein the second oblique angle is selectively adjustable independently of the first oblique angle.
 21. The surgical access device of claim 18, wherein the first suture path extends through a first side of the housing, wherein the second suture path extends through an opposed second side of the housing.
 22. The surgical access device of claim 18, wherein the first suture path is defined at least in part by a first opening in the side surface of the housing and the elongate opening in the sidewall of the cannula, wherein the second suture path is defined at least in part by a second opening in the side surface of the housing and a second opening in the sidewall of the cannula.
 23. The surgical access device of claim 17, wherein the sleeve includes an elastomeric portion configured to seal a distal end of the suture path.
 24. The surgical access device of claim 17, wherein the housing further comprises a removable upper portion, wherein the removeable upper portion defines the top surface and includes an opening configured to provide access to the working channel.
 25. A surgical access device, comprising: (a) a housing having a top surface, a side surface, and a tapered distal end; (b) a cannula extending distally from the tapered distal end of the housing along a longitudinal axis, wherein the cannula includes: (i) a cylindrical sidewall, (ii) a cylindrical recess formed in the cylindrical sidewall, and (iii) an elongate opening formed in the cylindrical recess; (c) a sleeve encircling the cannula and disposed within the cylindrical recess such that an outer surface of the sleeve is flush with an outer surface of the cylindrical sidewall of the cannula, wherein the sleeve provides a seal disposed at the elongate opening; (d) a working channel defined by the housing and the cannula, wherein the working channel is configured to receive a surgical instrument therethrough; and (e) a suture path, wherein the suture path extends inwardly through the side surface of the housing, directly from the housing to the cannula, across the working channel, through the elongate opening in the sidewall of the cannula, and outwardly through the seal provided by the sleeve.
 26. The surgical access device of claim 25, wherein the sleeve comprises an elastomer.
 27. The surgical access device of claim 25, wherein the suture path comprises a first suture path, wherein the surgical access device further comprises a second suture path that extends through the housing, across the working channel, through the sidewall of the cannula, and through the sleeve, wherein the second suture path is angled relative to the first suture path and relative to the longitudinal axis.
 28. The surgical access device of claim 27, wherein an angle between the first suture path and the second suture path is selectively adjustable.
 29. The surgical access device of claim 25, wherein the housing comprises an upper housing portion that defines the top surface and includes an upper opening, and a lower housing portion that defines the side surface and the tapered distal end, wherein the upper housing portion is selectively removable from the lower housing portion.
 30. The surgical access device of claim 29, wherein the upper opening is configured to provide access to the working channel. 